Scalp Alopecia After Greater Occipital Nerve Block Administration Mimicking Alopecia Areata

We report 3 cases of localized occipital alopecia after greater occipital nerve block injections containing triamcinolone acetonide 40 mg (1 mL). In 1 case, alopecia areata was initially suspected based on clinical and histologic features. However, deeper review revealed subcutaneous fat atrophy consistent with steroid-induced lipoatrophy. In all cases, alopecic patches corresponded precisely to prior injection sites. These findings highlight an underrecognized iatrogenic cause of patchy scalp alopecia that may mimic alopecia areata. Recognition of this entity is important to avoid misdiagnosis and unnecessary treatment.